Leishmania major: anti-leishmanial activity of Nuphar lutea extract mediated by the activation of transcription factor NF-κB

Here we report the effect of a partially purified alkaloid fraction (NUP) of Nuphar lutea on nuclear factor kappa B (NF-κB) expression and studied its mechanism of toxicity against Leishmania major in C3H mice peritoneal macrophages. NUP was found to be a mixture of thermo-stable dimeric sesquiterpene thioalkaloids containing mainly thionupharidines. The anti-leishmanial activity was shown to be mediated through the activation of NF-κB and increased iNOS production. Additionally, the nitric oxide inhibitor, N(G)-monomethyl-L-arginine (0.5mM) totally reverted the anti-leishmanial effect of NUP (0.25 and 0.5μg/ml). NUP was also shown to act as an anti-oxidant, almost completely inhibiting the macrophage respiratory burst activity. However, no elevated lysozyme (EC3.2.1.17) or β-galactosidase (EC3.2.1.23) activities were demonstrated in macrophages treated with NUP. This study suggests, that the activity of NUP is mediated by NF-κB activation and the production of nitric oxide which is dependent on the L-arginine:NO pathway.

IL-1-induced inflammation promotes development of leishmaniasis in susceptible BALB/c mice

The role of host-derived IL-1 on the course of Leishmania major infection in susceptible BALB/c mice was assessed. Manifestations of the disease were more severe in mice deficient in the physiological inhibitor of IL-1, the IL-1 receptor antagonist (IL-1Ra) in comparison with control mice. In mice lacking one of the IL-1 genes (IL-1alpha or IL-1beta), there was delayed development of the disease and more attenuated systemic inflammatory responses. IL-1alpha-deficient mice were slightly more resistant to L. major infection compared with IL-1beta-knockout mice. During disease progression in IL-1Ra KO and control mice, myeloid-derived suppressor cells invaded the spleen, concomitant to suppression of T cell-mediated immunity and expression of systemic high levels of pro-inflammatory cytokines. In IL-1-deficient mice, T(h)1 responses were still apparent, even at late stages of the disease. Thus, dose-dependent effects of IL-1 were shown to influence the pathogenesis of murine leishamaniasis in susceptible BALB/c mice. Physiological and supra-physiological levels of IL-1 in the microenvironment promoted an exacerbated form of disease, whereas sub-physiological doses of IL-1 induced a less progressive disease. Thus, manipulation of IL-1 levels in the host, using the IL-1Ra or specific antibodies, has the potential to alleviate symptoms of visceral manifestations of leishmaniasis.

Current status and perspectives of the immunotherapy of leishmaniasis

There is still a need for innovative and alternative therapies against leishmaniasis. Despite recent advances in immunology, effective immunotherapy against the disease has not yet been proven. Live, attenuated and dead parasites, purified and recombinant specific antigens, DNA vaccines as well as DC-based immunization that have been employed in the development of protective vaccine have not yet been adopted as immunotherapeutic agents. Recently, a commercially prophylactic vaccine (Leish-110f) was developed by BioPharm International, by constructing a recombinant fusion protein consisting of TSA (thiol-specific antioxidant), LmSTI1 (L. major stress-inducible protein 1) and LeIF (Leishmania elongation initiation factor). This vaccine, when administered together with the adjuvant monophosphoryl lipid A (MPL), either alone or plus squalene (MPL-SE) or AdjuPrime, protected mice against L. major and L. infantum infections. Also, Leishvacin (Leishvacin, Biobrs, Montes Carlos, State of Minas Gerais, Brazil), a commercial non-living promastigote polyvalent Leishmania vaccine administered either alone or combined with BCG, was found to be highly immunogenic against American CL in humans. Leishvacin alone was also found to be effective as a prophylactic vaccine, sensitizing lymphocytes from normal uninfected humans, which was further accelerated by recombinant GM-CSF. Standardization and additional carefully controlled studies in animals and humans, using these new vaccines and other immunomodulators in conjunction with various chemotherapeutic agents, are still required to determine the optimal conditions for the development of a potent anti-leishmanial immunotherapy and immunochemotherapy.

Nuphar lutea: in vitro anti-leishmanial activity against Leishmania major promastigotes and amastigotes

Several anti-leishmanial drugs of choice are of plant origin. Many of the available drugs against the disease are toxic and in certain cases parasite drug resistance is developed. The development of new compounds is urgently required.

AIMS OF THE STUDY

To determine the leishmanicidal activity of the Nuphar lutea plant extract against Leishmania major in vitro.

MATERIALS AND METHODS

The leishmanicidal activity of methanolic plant extract against L. major free living promastigotes and intracellular amastigotes was evaluated, using microscopic examinations and the enzymatic XTT assay.

RESULTS

Methanolic extract of N. lutea was highly effective against both Leishmania promastigotes and L. amastigotes (IC(50)=2+/-0.12 microg/ml; ID(50)=0.65+/-0.02 3 microg/ml; LD(50)=2.1+/-0.096 microg/ml, STI=3.23). The extract at 1.25 microg/ml totally eliminated the intracellular parasites within 3 days of treatment. Also, a synergistic anti-leishmanial activity was demonstrated with N. lutea extract combined with the anti-leishmanial drug--paromomycin. The partially purified N. lutea active component was found to be a thermo-stable alkaloid(s) with no electrical charge and is resistant to boiling and to methanol, dichloromethane and xylene treatment.

CONCLUSIONS

The present study suggests that N. lutea might be a potential source of anti-leishmanial compounds.

The immunomodulatory effect of Sambucol on leishmanial and malarial infections

A nontoxic dose of Sambucol, an immunomodulator commercially sold as an immune stimulator, was examined in murine models of leishmaniasis and malaria. Sambucol causes a shift in the immune response, as demonstrated in human monocyte cultures, to Th1 (inflammation-associated) responses. Treatment of leishmania-infected mice with Sambucol delayed the development of the disease. As there was no direct IN VITRO anti-leishmanial effect, the observed partial protection IN VIVO is most likely related to immune modulation. Although increased Th1 responses are associated with protection from leishmaniasis, they are considered to be the main immunopathological processes leading to cerebral malaria. Administration of Sambucol to mice prior to and following infection with Plasmodium berghei ANKA increased the incidence of cerebral malaria, while administration of Sambucol after infection had no effect on the disease. The results demonstrate how an inflammatory-like response may alleviate or exacerbate clinical symptoms of disease and hint at the importance of administration timing. The overall effect of immunomodulator administration depends on the ongoing immune response and the Th1/Th2 balance determined by both host and parasite defense mechanisms.

Taenia multiceps: a rare human cestode infection in Israel

Brain infestation caused by the metacestode of Taenia multiceps is a rare phenomenon in humans, but is fairly common among sheep in Mediterranean countries. No more than 150 human cases have been reported. In this present study, we report an unusual case of a huge intra-parenchymal cyst in a four-year-old girl caused by T. multiceps. No cross-reactivity between Echinococcus granulosus and T. multiceps antigens was demonstrated. After surgical removal of the cyst, followed by chemotherapeutic treatment with albendazole combined with praziquantel, the child recovered completely.

Huge hemispheric intraparenchymal cyst caused by Taenia multiceps in a child. Case report

The authors report an unusual case of a huge intraparenchymal cyst in a 4-year-old girl caused by Taenia multiceps infection. After surgical removal of the cyst, the child recovered completely. Brain infestation by coenurus is a rare disease, mainly reported in Africa, with a few case reports from patients in developed countries. Humans, especially young children, become intermediate hosts by ingesting eggs passed in the excrement of a definitive host, usually carnivores. In such cases, high mortality and morbidity rates have been reported. These rates decreased after the introduction of the modem neuroradiological techniques of computed tomography and magnetic resonance imaging.

Anti-amebic antibody activity in patients, determined with antigens prepared from virulent parasites (indirect hemagglutination assay and enzyme-linked immunosorbent assay)

BACKGROUND

The serology of amebiasis is affected by low sensitivity and specificity.

OBJECTIVES

To evaluate the advantage of the indirect hemagglutination assay and enzyme-linked immunosorbent assay in the diagnosis of amebiasis, using Entamoeba histolytica soluble antigen (macerated amebic antigens) prepared from four different virulent isolates, continuously cultivated in the presence of the original enteric bacteria.

METHODS

Using IHA and ELISA with MAA antigen we examined 147 sera samples from patients with gastrointestinal symptoms, and 11 sera from amebiasis cases (confirmed by microscopy and copro-antigen ELISA).

RESULTS

Of 104 of the 147 (70.7%) symptomatic cases that were amebiasis positive by IHA, 81 (55.1%) were positive by MAA-ELISA. In addition, of 11 amebiasis cases confirmed by microscopy and copro-antigen ELISA, 7 (64%) were amebiasis positive by both tests. Four species of bacteria were isolated from the ameba cultures: Escherichia coli, Morganella morganii, Proteus mirabilis, and Streptococcus lactis. Elimination of the bacteria from the cultures by an antibiotics cocktail containing gentamicin, imipenem, piperacillin-tazobactam and vancomycin was the preferred method. Absorption of patients' sera to bacterial antigen prior to serological analysis had only a marginal effect.

CONCLUSIONS

These results indicate a correlation of 61% between the ELISA developed in this study and the IHA tests in the diagnosis of amebiasis.

Alpha 2 macroglobulin activity in rats infected with Typanosoma lewisi and treated with cyclophosphamide and its effect on the malignancy of the disease

BACKGROUND & OBJECTIVES

Trypanosoma lewisi is a common, flagellated parasite of the rat. Our previous study showed that rabbits injected with serum collected from rats infected with Trypanosoma lewisi and treated with cyclophosphamide (CyI) produced high levels of antibodies against a new protein in the CyI rat serum.

RESULTS

In the present study, this protein was characterised as alpha2 macroglobulin (alpha2M) and the kinetics of its production and its influence on the malignancy of the disease were determined. In rats infected with T. lewisi, alpha2M was first demonstrated and peaked on the second day post-infection (972 microg/ml) and then reduced gradually, reaching a level of 32 microg/ml on the eighth day post-infection. However, in the CyI rats the level of alpha2M was gradually increased as the disease progressed, reaching a level of 890 microg/ml on the eighth day post-infection. Injection of both crude and purified alpha2M into rats infected with T. lewisi led to increased parasitaemia.

INTERPRETATION & CONCLUSION

The present study suggests that increased levels of alpha2M in the CyI rats contribute to the malignancy of the disease.

Leishmania major: in vitro and in vivo anti-leishmanial activity of paromomycin ointment (Leshcutan) combined with the immunomodulator Imiquimod

Paromomycin at 25, 50 and 100 microg/ml, inhibited the growth of Leishmania major amastigotes by 34.5%, 61.2%, 74.9% and 85.4%, 89.9%, 95.7% on the 2nd and the 4th day of treatment in culture, respectively. Methylbenzethonium chloride at 0.1 and 0.5 microg/ml and Imiquimod at 5 and 10 microg/ml, administered separately, inhibited the parasite development by 39.5% and 65.2% and 31.5% and 47.7%, respectively. Imiquimod (5-10 microg/ml) combined with either paromomycin (25, 50 and 100 microg/ml) or methylbenzethonium chloride (0.1 and 0.5 microg/ml) showed an anti-leishmanial additive effect. A 10 day topical treatment, twice daily, with an ointment containing 15% paromomycin and 12% methylbenzethonium chloride (Leshcutan), either undiluted or diluted 1:5 in soft white paraffin combined with 5% Imiquimod cream (Aldara), was as effective as Leshcutan given alone. The present study suggests that a combination of Aldara and Leshcutan is as effective as Leshcutan given alone in the topical treatment of CL caused by L. major.

Pathological developments mediated by cyclophosphamide in rats infected with Trypanosoma lewisi

Trypanosoma lewisi is an obligatory, flagellated parasite of the rat. Despite the fact that naturally the rats overcome the disease, a lethal infection can be induced by the administration of an immunosuppressive agent, i.e. cyclophosphamide (Cy). In the Cy treated infected rats (CyI) the severity of the trypanosome infection was demonstrated in the internal organs, in the following order: lungs>liver>heart>spleen>kidney. The parasites were not detected in the brain. The accumulation of the parasites in the lungs led to the development of hemorrhagic inflammatory foci. The rupture of blood vessels was accompanied by lymphocyte infiltrations into the damaged tissues and multiple foci of edema around the blood vessels. In most cases the lungs were dark brown in color due to intra-alveolar hemorrhages. The spleen of the CyI rats showed general deformation of the tissue's architecture, migration of macrophages and cell depletion due to the Cy action. The liver showed inflammatory hemorrhagic foci associated with massive destruction of the parenchyma. In spite of the heavy parasitemia (>50%) developed in the CyI rats the brain remained free of parasites, which might explain the non-virulent character of this parasite compared to the African trypanosomes.

Immunological responses and the pattern of disease in mice infected with transfected Leishmania major constitutively expressing active IL-1alpha

Immunity against leishmaniasis is mediated mainly by CD4+ T lymphocytes, which function by secreting cytokines, which in turn activate various effector mechanisms. Interleukin 1 (IL-1) represents one of the most pleiotropic proinflammatory cytokines and is required for normal regulation of Th1/Th2 responses. The aim of this study was to induce the expression of the inflammatory cytokine IL-1alpha by Leishmania parasites and to determine its effect on the parasite development. Leishmania constitutively producing IL-1alpha was engineered, using the pX63Hyg-IL-1alpha vector. IL-1alpha was produced by both promastigotes and amastigotes, and remained unchanged after transformation and development in mice. The protection against the disease achieved in BALB/c mice by the transfected parasites was superior to that obtained with the wild type. One month after infection a nodule was demonstrated in 22% and 60% of the mice inoculated with transfected parasites and the wild type, respectively. This tendency continued for an additional 2.5 months, after which the rate of infection increased to 90% and 100% in these two groups, respectively. The present study suggests that, during initial infection, the pathway of IL-1alpha production and its accessibility to the immunological cells might be important in the outcome of leishmanial infection.

The flow-cytometry-based evaluation of cellular immunity in cases of cutaneous leishmaniasis and healthy controls from the endemic area in southern Israel

Only limited data are available on the early immunological events associated with human cutaneous leishmaniasis (CL). In this study, peripheral-blood mononuclear cells were obtained from 66 individuals (34 patients with cutaneous lesions and 32 apparently healthy controls) who had each spent no more than 3 months in the endemic region of Qetzioth, in southern Israel. These cells' responses to Leishmania major antigen were then explored, by the flow-cytometry-based evaluation of blast transformation (BT). The lymphocytes from 17 (50%) of the patients but only one (3%) of the controls displayed BT. When, in an ELISA, most (52) of the subjects were checked for anti-L. major antibodies, none of the 22 controls investigated but 19 (63%) of the 30 patients were found seropositive. Although 14 (47%) of the 30 patients who were checked for antibodies were BT-positive, the seropositive patients were not significantly more or less likely to be BT-positive than the seronegative patients (P<0.919). These data indicate that, in CL, the hosts' cellular and humoral responses develop independently within the first 3 months post-infection, but further investigation is required to confirm this hypothesis.

Repeated treatment of cystic echinococcosis in patients with a long-term immunological response after successful surgical cyst removal

Six cystic echinococcosis patients underwent surgery for the removal of echinococcal cysts. All were treated with albendazole prior to and following treatment. After surgery, no cysts were detected in five of the six patients examined. Both ELISA and immunoblot analysis have been used to determine specific IgG, IgG4 and IgE activities. Total elimination of IgG and IgG4 was not achieved in any of the patients studied. Prior to the first surgery/treatment, specific IgG, IgG4 and IgE antibodies were demonstrated in all patients, except one who did not show any IgE activity. The first treatment was followed by highly elevated IgE in two patients; in one of them it was further combined with an apparent decrease in IgG activity. Repeated treatment with albendazole given 0.8-8.5 years after the first treatment/surgery was followed by either moderate or highly reduced IgE activity in two patients, respectively, and a slight increase in IgG4 in another patient. A third course of treatment, given 2-2.5 years after the second treatment, barely affected the antibody activities. The present study suggests that anti-echinoccocal antibody activity may remain high many years after successful cyst removal. Determination of IgG, IgG4 and IgE responses is preferable for the assessment of treatment results. The presence of anti-echinococcal antibodies after surgery with no cyst detection does not necessarily indicate an active echinococcal infection.

Case report: clinical and serological evaluation of echinococcosis of the spine

A 53-year-old male with a severe destructive lesion of the L4 vertebral body caused by an Echinococcus granulosus hydatid cyst was studied. He underwent surgery twice, and was treated continuously with albendazole, followed by albendazole combined with praziquantel. Specific anti-echinococcal immunoglobulin (Ig) G, IgG4, and IgE activities before and after surgery were further determined. In spite of long-term chemotherapeutic treatment combined with surgery, no eradication of the disease was achieved.

Benzimidazole treatment of cystic echinococcosis

Hydatidosis (cystic echinococcosis, CE) constitutes a serious public health problem worldwide. Total surgical removal of a hydatid cyst is still considered the gold standard treatment for CE. Percutaneous treatment (PAIR), using either hypertonic saline or alcohol as a larvacidal agent, appears to be an additional effective form of treatment. Benzimidazoles (albendazole, ABZ; mebendazole, MBZ), given either alone or combined with praziquantel (PZ) are currently used for the treatment of non-surgical cases and as a supplementary treatment prior and post-surgery. Combined chemotherapy was found to be more effective than either of the agents given alone. ABZ is easily absorbed and more effective than MBZ. ABZ (12-15 mg/kg/day) and MBZ (30-70 mg/kg/day) given for 14-20 days prior to surgery and continued for an additional 3-24 months in a cyclic monthly form were found effective against the disease. Either increased or decreased circulating antigen levels, which consequently cause changes in the humoral (IgG, IgG1, IgG4, IgE) immune responses, have a prognostic value in successfully treated CE cases. However, although the cellular immune response to echinococcal antigens decreased in improved or cured CE patients, it was not considered of practical use in determining treatment efficacy. In certain cases successful treatment was also followed by elevated eosinophilia and erythrocyte sedimentation rates. In the present article, the mechanism of drug activities as well as the development of resistance against the drugs available are further discussed.

Prevalence of cystic echinococcosis among Muslim and Jewish populations in southern Israel

Following a review of records at the Soroka University Medical Center (SUMC) showing a recent increase in the annual incidence of hydatidosis among the Bedouin population of southern Israel, a seroepidemiological survey was conducted. A total of 1439 blood samples were collected from Bedouins and Jews living in the Negev area in southern Israel. An enzyme-linked immunosorbent assay (ELISA) for immunoglobulin G, indirect haemagglutination (IHA) and immunoelectrophoresis (IEP) were used to detect anti-Echinococcus granulosus antibodies. The seroprevalence in the Bedouin group was 0.68% (7/1026), including two children under the age of 10. Among Jews, a seroprevalence of 0.5% was recorded in patients over 60 years of age only. A high rate of infection was shown in goats and sheep slaughtered in abattoirs in Bedouin localities. The results indicate that echinococcosis is a common disease in the Muslim communities of southern Israel.

Interleukin 1alpha activity of peritoneal and bone marrow macrophages infected with Leishmania major and Leishmania donovani in vitro

In this study, the pattern of interleukin-1alpha (IL-1alpha) production by both peritoneal (PM) and bone marrow macrophages (BMM) from resistant (C3H/HeJ) and susceptible (BALB/c) mice was investigated, using a bioassay and an IL-1alpha-specific ELISA kit. PM from normal uninfected mice showed either an initial high (C3H/HeJ) or a neglected (BALB/c) level of IL-1alpha activity, respectively, probably due to thioglycollate stimulation. Infection with Leishmania major induced only a marginal effect on IL-1 production by both cells. Normal, uninfected and unstimulated BMM from both mice did not produce IL-1alpha over a 7-day period of cultivation in vitro. Upon stimulation with either lipopolysaccharide (LPS) (BALB/c) or concanavalin A (Con A) (C3H/HeJ), both cell types produced IL-1alpha that peaked within the first 12-24 h following stimulation. BMM from C3H/HeJ and BALB/c mice failed to produce IL-1alpha when infected in vitro with L. major or L. donovani promastigotes. However, infection with these two parasites did not interfere with the capability of the host cell to produce IL-1alpha when stimulated with LPS or Con A. The level of IL-1alpha production was independent of the degree of parasitization of the macrophages. Similar results were observed with IL-1beta and IL-6 production by BMM, even though their levels were generally slightly higher than those obtained with IL-1alpha.

Giardia lamblia carriage in Israeli Bedouin infants: risk factors and consequences

Giardiasis is a common protozoan infection, with varying clinical manifestations. We investigated the associations between Giardia lamblia carriage and environmental, family, illness, and growth characteristics. Bedouin infants (n=234) were followed from birth to age 18-23 months. At monthly home visits, stool samples were obtained, history of illness was determined, and an environmental assessment was done. The comparisons presented are between 4 groups defined by length of carriage of G. lamblia. Study children had a mean+/-SD of 4.1+/-2.9 diarrhea episodes. No illness, environmental, or family characteristics were associated with length of carriage. Significant differences were found in weight-for-age and weight-for-height z scores between the never-positive-for-G. lamblia group and all other carriage groups combined. Faltering growth was shown to be subsequent to G. lamblia infection rather than preceding it. Our findings confirm that G. lamblia carriage is not associated with diarrhea. However, the effect on growth deserves further investigation.

Natural history of Giardia lamblia and Cryptosporidium infections in a cohort of Israeli Bedouin infants: a study of a population in transition

The natural history of Giardia lamblia and Cryptosporidium infections were determined in a cohort of 164 Bedouin children, from a population not previously studied, which is in transition from nomadism to a settled life style. Stools were sampled monthly from birth to two years of age and at all diarrhea episodes. The risk of infection with G. lamblia and Cryptosporidium infection by age two was 91.5% and 48.8%, respectively. Cryptosporidium prevalence was 3-4% at all ages, whereas G. lamblia prevalence was > 30% after age one. Giardia lamblia and Cryptosporidium asymptomatic detection rates were high, 28.5% and 1.6%, respectively. Detection of G. lamblia was higher in diarrhea episode samples obtained before six months of age, but after that age and overall, the detection was lower than in nondiarrhea samples (odds ratio [OR] = 0.8, 95% confidence interval [CI] = 0.7-0.9, P < 0.05). Detection rates of C. parvum were higher in episode-related samples in all age groups (OR = 2.8, 95% CI = 1.9-4.2, P < 0.05) and infections in boys were more frequently symptomatic than in girls. While G. lamblia does not appear to be a consistent pathogen in this population where it is hyperendemic, Cryptosporidium has been shown to be an important cause of diarrhea in young children in the community.

Cellular and humoral immune responses of hydatidosis patients to Echinococcus granulosus purified antigens

The cellular and humoral immune responses of 41 hydatidosis patients, 12 healthy uninfected individuals, and seven patients with other parasitic diseases were determined using serologic and lymphoproliferative assays (LPAs), respectively. Echinococcal antigens were obtained by gel filtration of crude hydatid cyst fluid (HCF) on a Sephadex G-200 column. The fractions contained either a mixture of antigens A plus B or antigen B alone that was further enriched by boiling. All the hydatidosis patients responded positively by LPA to either crude or purified echinococcal antigens: 95% of them responded to either crude HCF, or a mixture of antigens A plus B and 83% to antigen B alone. The degree of the response to crude HCF (mean stimulation index [SI] = 75.3) was higher than that of purified antigens (SI = 39.1 for a mixture of antigens A plus B and SI = 36.9 for antigen B alone). No positive LPA response was obtained with the control groups. Serologic examinations showed that 78% of cases were positive by immunoblot, 73% by indirect hemagglutination, and 46% by immunoelectrophoresis. No correlation between the degree of cellular and humoral responsiveness to both crude and purified echinococcal antigens was observed. Nine of the 41 patients examined who were serologically negative also developed a high lymphoproliferative (LP) response to either crude or purified echinococcal antigens. The LP response remained positive over a long period after successful treatment. No relationship was observed between the results of treatment and the LP response. The present study indicates that the LPA could be used as an additional tool for the diagnosis of hydatid disease, particularly in seronegative cases, although it is unsuitable for effective monitoring treatment/surgery.

Evaluation of an enzyme immunoassay for the detection of Cryptosporidium spp. in stool specimens from infants and young children in field studies

Diagnosis of Cryptosporidium is made by the identification of oocysts in stool specimens. Screening in field studies relies mainly on acid-fast staining followed by microscopic examination. The more sensitive immunofluorescent antibody (IFA) staining method is time-consuming, may involve technical difficulties, and is extremely costly as a screening procedure in field studies. We evaluated the diagnostic utility of a commercially available enzyme immunoassay (EIA), which detects Cryptosporidium-specific antigen, in 204 unprocessed stool specimens obtained from patients less than three years of age from a field study in southern Israel. When compared with the routine screening procedure applied in this field study (screening by acid-fast staining and microscopy after concentration, and confirmation of positive results by IFA), both the sensitivity and specificity were 98%. Of 139 specimens negative by microscopy, 13 (9.3%) were positive by the EIA. Eleven of these were confirmed by inhibition with antibody to Cryptosporidia-specific antigen. The EIA is an important tool for identifying Cryptosporidium in fecal specimens in field studies since it is sensitive, specific, simple to use, and unaffected by the presence of a preservative.

Leishmania major: histopathological responses before and after topical treatment in experimental animals

The cellular response in the cutaneous leishmaniasis lesion (CL), of BALB/c mice treated topically with an ointment composed of 15% paromomycin and 12% methylbenzethonium chloride (PR-ointment) was studied. In the infected, untreated control group, the lesion showed progressive necrosis with an increase in the number of parasites, macrophages, lymphocytes, and polymorphonuclear cells over a period of 18 weeks. In the PR ointment-treated group, complete healing of the lesion was observed 4 weeks after termination of treatment, but total elimination of the parasites from the lesion was observed only 2 weeks later. A marked reduction in the number of macrophages and polymorphonuclear cells was observed during the healing process. A similar phenomenon was observed with mice inoculated intraperitoneally with paromomycin alone, although total elimination of the parasites from the lesions of these mice was not demonstrated over a period of 18 weeks. Neither L3T4 helper T cells nor Ly2 cytotoxic suppressor T cells were detected in the CL lesion, either before or after treatment.

Leishmania major: antileishmanial activity of methylbenzethonium chloride

Methylbenzethonium chloride (MBCl) decreased the growth of Leishmania major promastigotes and amastigotes in vitro. This decrease occurred during 4 days of exposure to the drug at concentrations of 0.1 to 2.5 micrograms ml-1. MBCl at 2 micrograms ml-1 killed almost 100% of the free living promastigotes and 87% of amastigotes within 4 days of treatment. Electron microscopy studies showed marked swelling of mitochondria in treated parasites. A possible additional effect on the parasite surface membrane is discussed.

Topical treatment of cutaneous leishmaniasis

Sixty-seven patients, 19 females and 48 males, 4-66 years old, suffering from lesions of cutaneous leishmaniasis were treated topically with an ointment comprising 15% paromomycin sulfate and 12% methylbenzethonium chloride in white soft paraffin (P-ointment, U.K. patent GB117237A). After 10 days of treatment, twice daily, the lesions in 72% of the treated patients were free of parasites, 15% became free within an additional 20 days, without further treatment, and 13% failed to respond. Pigmentation developed in 18% of the treated lesions and inflammation of varying degree was associated with the treatment. These developments did not affect the clinical healing process which was generally completed in a period of 10-30 days after termination of treatment. In addition, 94% of the treated lesions healed with little or no scarring. No adverse clinical or laboratory side effects were observed except for a burning sensation at the site of treatment. Parasites isolated from patients who failed to respond to topical treatment were found to be susceptible to PR-MBCl in both in vitro infected macrophages and in vivo in experimentally infected BALB/c mice.

Protection of guinea pigs against cutaneous leishmaniasis by combined infection and chemotherapy

A paromomycin and methylbenzethonium chloride ointment cured Leishmania enriettii infections in guinea pigs. Amastigotes were totally eliminated from the treated lesion after 10 days of treatment. A delayed effect also occurred on untreated lesions in the same animals. Lesions treated at various times after infection permitted protective immunity to develop, and 90% of treated animals were refractory to reinfection.

Leishmania major: excreted factor, calcium ions, and the survival of amastigotes

Mouse macrophages infected with amastigotes of Leishmania major contain about 40% more intracellular exchangeable calcium than control macrophages. Similar elevation of intracellular exchangeable calcium was observed in macrophages engulfing red blood cells coated with purified excreted factor from L. major. The rate of cytolysis of red blood cells coated with excreted factor was significantly lower than that of uncoated controls. Excreted factor strongly binds calcium; thus, the possible role of a microenvironment rich in calcium bound to excreted factor within the phagolysosome in protecting the amastigotes may be considered.

Leishmania tropica: protective response in C3H mice vaccinated with excreted factor crosslinked with the synthetic adjuvant, muramyl dipeptide

Excreted factor, an immunosuppressive, acidic polysaccharide released by promastigotes of Leishmania tropica major in culture, was chemically crosslinked to the synthetic adjuvant muramyl dipeptide via the bifunctional imidoester dimethyladipimidate and poly-L-lysine. This conjugate, an uncrosslinked mixture of the components, or each of the components alone were injected one to three times into different groups of 8- to 12-week-old C3H mice. The mice were challenged 2 weeks after the last injection with 2 X 10(6) promastigotes of L. t. major in the base of the tail. For the next 5 weeks, the animals were monitored for number of parasites and size of the lesion which developed at the site of the challenge. Mice receiving one intraperitoneal injection of the conjugate were partially protected against challenge. Treated animals had higher initial parasite numbers but showed a more rapid clearing of the parasites. Furthermore, the treated animals developed smaller lesions that healed quicker than did those of the control groups. Multiple injections, or injection into a footpad, rather than intraperitoneally, reduced the ability to elicit a protective response. On the other hand, muramyl dipeptide injected into a footpad was partially protective. Antibody production to excreted factor, which was measured by indirect hemagglutination of sensitized erythrocytes, was detected after challenge in mice which had received conjugate or conjugate components. A delayed hypersensitivity reaction (measured by skin testing) was not detected in any of the groups prior to challenge.

Development of topical treatment for cutaneous leishmaniasis caused by Leishmania major in experimental animals

Topical treatment, with drug-containing ointments, of cutaneous leishmaniasis caused by Leishmania major in BALB/c mice was studied. Twenty chemotherapeutic agents having potential or established antileishmanial activity were formulated in different ointment and cream bases. Only 15% paromomycin sulfate with 12% methylbenzethonium chloride, 12% benzethonium chloride, 12% cetalkonium chloride, or 12% dimethyl sulfoxide, all incorporated in white soft paraffin (United Kingdom patent application no. 2117237A), were completely effective. Topical treatment twice daily for 6 or more days caused total elimination of the parasites and healing of the lesion in all treated mice. All the other antileishmanial compounds, including sodium stibogluconate, pentamidine, amphotericin B, emetine hydrochloride, metronidazole, co-trimoxazole, allopurinol, and rifampin, either showed a slight effect on the parasites or were highly toxic to the animal host at the concentrations tested.

Comparison of the effect of various stimuli on the leishmaniacidal capacity of human monocytes in vitro

Leishmania organisms are obligate intracellular parasites of mammalian mononuclear phagocytes in vivo. In order to study the interactions of these parasites and mononuclear phagocytes, we have used a model of infection of Leishmania major in human monocytes in vitro. The presence of intracellular parasites did not alter the normal secretion of lysozyme or result in increased secretion of prostaglandin E2 (PGE2) or superoxide anion by the monocytes. Addition of concanavalin A (Con A), which binds to a specific membrane receptor, zymosan particles or endotoxin to infected monocyte monolayers, resulted in the expected increase in PGE2 secretion. In addition, the production of superoxide by infected monocytes treated with phorbol myristate acetate was not different from control uninfected cultures. Despite this evidence of biochemical activation, neither endotoxin, zymosan nor Con A had any parasiticidal effect on the intracellular parasites. In contrast, Con A-induced lymphokines from human mononuclear cells resulted in an increased killing of the intracellular amastigotes. These studies have shown that the induction of leishmaniacidal capacity of human monocytes is dependent on the type of stimulus used to induce activation.

Growth inhibition of Leishmania tropica amastigotes in vitro by rifampicin combined with amphotericin B

Rifampicin and Amphotericin B (AMB) were studied separately and in combination to determine their effect in vitro on intracellular Leishmania tropica amastigotes. On the fourth day of treatment, rifampicin at 200 micrograms ml-1 or AMB at 0.15 microgram ml-1 reduced the parasites' survival index (PSI) to 10% compared with the untreated control. In combination, there was a significant synergistic effect at several concentrations. The synergistic therapeutic effects were not accompanied by toxicity to the host cells, although each drug alone caused cellular degeneration in the ultrastructure of the parasites with the formation of large autophagic-like vacuoles, while the combination increased the percentage of degenerate cells.

Cutaneous leishmaniasis: treatment with ketoconazole

A 17-year-old boy with an eight-month history of cutaneous leishmaniasis on the left earlobe was treated with ketoconazole for a period of four weeks. The patient showed excellent improvement both clinically and protozoologically. Ketoconazole, a new imidazole bound covalently to piperazine, has been developed as a broad spectrum antimycotic agent and appears to be a good antileishmanial drug.

Leishmania tropica and Leishmania donovani: solid phase radioimmunoassay using leishmanial excreted factor

A radioimmunoassay for the quantitative determination of anti-leishmanial excreted factor (EF) antibody in rabbit sera was developed. The assay, using Leishmania tropica and Leishmania donovani promastigotes EF, purified by either extraction with phenol followed by fractionation on a Sephadex G-100 column or by the dissociation of EF antibody complexes, was shown to be sensitive and reproducible. Using monospecific anti-EF antibodies, levels of as low as 0.06-0.12 micrograms/ml of anti-EF IgG could be detected. The specificity of the assay was assessed by inhibition with homologous and heterologous EF. Only minor cross-reactivity with heterologous EF was observed, and as little as 2.5 micrograms/ml of EF could be detected. Sera from kala-azar patients showed only 1.8-3.1 times more anti-EF activity, as compared with uninfected controls. No specificity was observed with sera from kala-azar patients with regard to the type of EF used. Almost the same activity was obtained with both EF from L. tropica and L. donovani. No anti-EF antibodies were detected in sera from patients with cutaneous leishmaniasis.

Chemotherapeutic activity of rifampicin on leishmanial amastigotes and promastigotes in vitro

Rifampicin reduced the in vitro growth of Leishmania tropica major promastigotes and amastigotes: 100 micrograms/ml reducing the growth of amastigotes on Day 2 and 250 to 500 micrograms/ml reducing the growth of promastigotes on Day 1. A distinct effect of solvents was noted. Methanol, dimethylsulfoxide and Tween 80 appeared to increase drug effectiveness. Pretreatment of L. tropica major promastigotes with 200 micrograms/ml rifampicin for 3 days had no effect on either macrophage engulfment of the treated promastigotes or their transformation into amastigotes. Intracellular amastigotes treated for only 3 days recovered and 8-day treatment with 100 micrograms/ml rifampicin was insufficient to totally eliminate the amastigotes. The promastigotes of different strains of Leishmania showed different sensitivities to rifampicin, L. aethiopica being more sensitive than L. donovani, L. tropica minor and L. tropica major.

Leishmanial excreted factors (EFs): purification by affinity chromatography

Leishmania species grown in culture excrete a polyanionic, carbohydrate-rich factor (EF) which binds to antibodies produced in rabbits against the parent Leishmania species. EF, previously purified by physical and chemical methods, was purified by affinity chromatography on a Ricinus lectin column. The purified samples were characterised and analysed. The results show a notable proportion of galactose in EF and clarify the reasons for its polyanionic properties. Heterogenicity of EF is demonstrated and discussed.

Binding of Leishmania promastigotes to macrophages

Leishmania tropica promastigotes are easily attached to and engulfed by C3H peritoneal macrophages in vitro at 37 degrees C. Different sugars at 0.3-0.5 M inhibited in vitro the attachment of L. tropica promastigotes to C3H peritoneal macrophages with lactose (Gal-beta [1 leads to 4]Glc) being the most efficient. Inhibition of attachment is also affected by pre-treatment of promastigotes with galactose oxidase. Oligosaccharides extending from promastigote and amastigote cell surfaces contain an important proportion of non-reducing galactose as does the carbohydrate-rich factor (EF) excreted by promastigotes of L. tropica and L. donovani. This study suggests that Leishmania, an obligatory intracellular parasite, uses as a means of entering the host cell a cellular mechanism similar to that used in the removal of damaged cells from blood circulation. This mechanism is assumed to take advantage of the exposed sugars, particularly the exposed non-reducing galactose, on the parasite surface during the stage of attachment. Once the parasite is inside the cell, the EF it produces might have a protective function, being inhibitory to some of the host cell lysosomal enzymes.